Provider Demographics
NPI:1053938282
Name:GOODFRIEND, LAURIE BETH (RDH)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:BETH
Last Name:GOODFRIEND
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 TENNYSON RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2159
Mailing Address - Country:US
Mailing Address - Phone:240-462-7320
Mailing Address - Fax:
Practice Address - Street 1:8401 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5803
Practice Address - Country:US
Practice Address - Phone:301-779-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4625124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist